Breech birth

Most babies prepare to enter this world head first. A small percentage of babies, however, don’t make that final turn and end up offering themselves feet or fanny first. This is called breech presentation.

We’re not sure why these babies don’t turn, but it does appear more common under these circumstances:
• When there has been a previous breech presentation
• In pregnancies of multiples (twins, triplets…)
• When the amniotic fluid is abnormally low or high
• If a woman has placenta previa
• If her uterus is abnormally shaped or if she has fibroids
• If there is a history of premature delivery

If a breech presentation is suspected, an ultrasound will confirm it. Most breech babies are born healthy, but there may be a slight increase in the risk of the baby having a birth defect and closer examination may be offered.

When a baby is in a breech position, health care providers will try to encourage it to turn into the head down position some time between 32 and 37 weeks. There are different ways to attempt this and it’s important for a woman to discuss the options with her provider to determine which is safest for her pregnancy. These are a few of the options (no guarantees that any of them will work, though):
• External version – This may require medication to relax mom’s uterus. Essentially, this involves the provider pushing on the lower abdomen to rotate the baby. It is monitored by ultrasound and the fetal heart rate is checked regularly. This is not an option for women carrying multiples, in cases of low amniotic fluid, or when a woman has had previous c-sections.
• Chiropractic care – The Webster technique is used to reduce stress on the woman’s pelvis, optimize its mobility, decrease the tension on the uterus and relax supporting ligaments. This regional relaxation makes it easier for the baby to turn on his own.
• Breech tilt – Mom lies flat on her back and then raises her hips about 12 inches off the floor and supports them with pillows. She stays in this position for about ten minutes, three times per day. This can be alternated with Mom resting her head on a pillow and raising her hips up, resting on her knees. These positional shifts let gravity help move her baby.
• Hypnosis – A good hypnotherapist may be able to place a woman in a state of deep relaxation which might make it easier for her baby to turn.
• Moxibustion – Used to stimulate the baby’s movement, this is an ancient Chinese technique that involves burning herbs and focusing on acupressure points, typically performed by an accupuncturist.

When babies still don’t turn, most will be delivered by cesarean section, though not before 39 weeks if all is going smoothly. While most providers will not consider it, there are occasional circumstances when a vaginal delivery might be possible in a breech position. In such cases, a woman wants to be sure that her provider is well experienced in these types of deliveries. She should be mindful that cesarean may still be a necessary final outcome.

Watching the new PBS series “Call the Midwife” last week inspired this post. Did you see it? What did you think?

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